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Rhythmic auditory stimulation to reduce falls in healthy elderly and patients with Parkinson's disease: a randomized control trial




Hurt-Thaut, Corene P., author
Kees, Nathalie, advisor
Davis, William, advisor
Gloeckner, Gene, committee member
Tracy, Brian, committee member

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Background: The risk of falling over the age of 65 is 33% for healthy elderly and 40% for a person with Parkinson's disease over a one year period. A training program to reduce this risk could have significant impacts on health care cost and assist in maintenance of patient safety, independence, and quality of life. Objective: The purpose of this study was to investigate whether a home-based Rhythmic Auditory Stimulation (RAS) gait training program would have an effect on gait parameters associated with falls in healthy elderly and PD patients with a history of frequent falls. Method: Twenty healthy elderly and twenty PD patients were randomly assigned to a continuous treatment group which underwent 24 weeks with RAS, or a control group which trained intermittently eight weeks with RAS, eight weeks without, for twenty-four weeks. Changes in ankle dorsiflexion, cadence, velocity, stride length, the Berg Balance Scale, fear of falling, the Barthel Index, the timed "up and go" test (TUG) and frequency and severity of falls were evaluated. Results: The results for the healthy elderly indicated a statistically significant increase in degrees of dorsiflexion, velocity, cadence, stride length, and the Berg Balance Scale in both groups at each time point, with large effect sizes. Results for the PD treatment groups indicated that there were significant differences in dorsiflexion (p<.009), cadence (p<.009), velocity (p<.0001), stride length (p<.0003), severity level 1 falls (p<.003), and fear of falling (p<.0004), when comparing treatments, with large effect sizes. A correlation matrix combining all 40 participants revealed a significant correlation between fear of falling and severity level 1 falls at 8 weeks (0.48, p<.004); severity level 2 falls at all time periods [baseline (0.42, p<.01), 8 weeks (0.42, p<.01), 16 weeks (0.42, p<.01), and 24 weeks (0.42, p<.01)]; and severity level 3 falls at 24 week 0.35, p<.04). Other correlations with falls in the healthy elderly group included severity level 2 falls and the Berg Balance scale (0.65, p<0.002), severity level 2 and 3 falls (0.65, p< .002), severity level 3 falls and stride length (0.57, p<.002) and velocity (0.65, p<.002). Significant interactions were seen between the intermittent and continuous treatment groups in dorsiflexion [F (2,72)=9.54, p<.0002], stride length [F (2,72)=8.17, p<.0006], velocity [F (2,72)=7.92, p<.0006], fear of falling [F (2, 72)=12.97, p<.0001], and the Berg Scale [F (2,72)=1.92, p<.15]. Conclusions: The findings offer evidence that continuous and intermittent RAS treatment over time can be effective tools to reduce falls in healthy elderly and patients with Parkinson's disease, however continuous RAS treatment results in greater gains in gait parameters associated with safety. Two single variables, the Berg Balance Scale and velocity were seen as a significant fall predictor for healthy elderly. The Barthel Index was a significant indicator for falls with injury for the Parkinson's participants.


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Parkinson's disease
healthy elderly
rhythmic auditory stimulation


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